Video Game Helps Kids Battle Depression

For depressed teenagers, a computer game may provide an alternative to in-person counseling, researchers found.

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This study indicated that for depressed teenagers, a computer game known as SPARX may provide an effective alternative to in-person counseling.

Note that effectiveness of SPARX wasn't related to sex, age, ethnicity, or setting, but participants who were more depressed at baseline had a significantly greater reduction in depression scores with SPARX than those who were less depressed.

For depressed teenagers, a computer game may provide an alternative to in-person counseling, researchers found.

In a multicenter trial in New Zealand, playing the cognitive behavioral video game SPARX at home was noninferior to usual clinical counseling in terms of improvements in self-reported depression scores, Sally Merry, MD, of the University of Auckland, and colleagues reported online in BMJ.

"The results are more impressive when it is considered that SPARX was entirely a self-help resource," they wrote. "The only contact with a clinician was at recruitment, and the only input from health professionals during the course of treatment was a brief phone call after a month."

Less than a fifth of young people with depressive disorder are treated, the researchers said, partly because young people may be reluctant to seek traditional help.

Being able to have therapy on the computer, however, may offer a potential way to appeal to today's "digital natives," they wrote.

So to evaluate whether SPARX (Smart, Positive, Active, Realistic, X-factor thoughts) could reduce depressive symptoms in adolescents who sought help compared with usual treatment, the researchers conducted a randomized controlled trial at 24 primary healthcare sites in New Zealand, which included school-based counseling services, youth clinics, and general practices.

A total of 187 adolescents ages 12 to 19 who sought help for depressive symptoms but had no major risk of self-harm were enrolled, and 168 completed 3 months of follow-up.

The game is set up as an interactive fantasy in which the user chooses an avatar that is charged with restoring balance in a word dominated by "gloomy negative automatic thoughts." Cognitive behavioral therapy is delivered during those challenges via a guide who puts the game into context, provides education, gauges mood, and sets and monitors real-life challenges.

The player typically spends 20 to 40 minutes on each of seven modules, delivered over 4 to 7 weeks.

Overall, Merry and colleagues found that SPARX was noninferior to treatment as usual.

In a per-protocol analysis, SPARX reduced self-reported depressive symptoms by a mean of 10.32 points, compared with a mean reduction of 7.59 points for those who had treatment as usual (P=0.079).

Noninferiority also was confirmed in the intention-to-treat analysis, with a mean reduction of 9.05 points on self-rated depression scales for SPARX compared with a mean 7.45- point reduction for usual care.

In the per-protocol analysis, remission rates were significantly higher with SPARX than with usual care (43.7% versus 26.4%, P=0.03), and response rates didn't differ significantly between groups. The authors noted that response and remission rates with SPARX "compare favorably with other effective monotherapies, including antidepressants and cognitive behavioral therapy."

Merry and colleagues found that effectiveness of SPARX wasn't related to sex, age, ethnicity, or setting, but participants who were more depressed at baseline had a significantly greater reduction in depression scores with SPARX than those who were less depressed (P=0.038).

They added that there were no differences in adverse events that were potentially related to the intervention.

Although the study was limited because data on usual care were not as robust as had been hoped, the researchers still concluded that SPARX "was at least as good as treatment as usual in primary healthcare sites in New Zealand, but would be cheaper and easier to disseminate."

The study was supported by the New Zealand Ministry of Health.

The researchers reported no conflicts of interest.

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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